Articles

Notes From Pahoa—How Our Clinic Is Surviving the Kilauea Volcano

On Dec. 16, representatives from the state’s Civil Defense Agency walked door to door in the Pahoa shopping center and gave us the order we all knew was coming: “Prepare to evacuate!”

Although Kilauea volcano has been continuously erupting since 1983, the June 27 eruption of slow-moving lava threatened the livelihoods and the very existence of Pahoa, a community with around 945 residents on the Big Island of Hawai’i—setting vegetation and homes ablaze as it slithered along. The eruptions had not factored into our decision in 2009 to open the community-directed Puna Community Medical Center (PCMC) in the Puna district on the east coast of the island.

As I pulled into the shopping center’s gas station, I realized that I was encountering the first immediate consequences of the lava. The station was pumping out the last of its fuel (premium only at $3.80/gallon), and at some point today, there would be no gas. The tanks would be filled with a foam and water mixture to prevent explosions and essentially made unusable for the foreseeable future. The supermarket was closing down; the ACE Hardware and the tire center would be gone soon too.

The next day, a 40-foot shipping container donated by Matson Lines parked next to our clinic annex, the new clinic space on the south end of Pahoa Village that we were hastily creating out of a three-bedroom apartment and was not quite fully operational as yet. We had packed up our former clinic and placed supplies and equipment in the annex, or stored them in the container where they would stay for the next days, weeks, months or until it became clear how things would work out.

The entire transition was fearsomely complicated—involving our ability to provide healthcare services, the general safety of staff and patients, our financial reserves and the real threat to the town’s survival. It all seemed so surreal, and to be doing it under time pressure felt simply nuts.

As I write this, it seems clear that no matter how circumstances twist and turn in the immediate future, life will never be what it was before. The community will likely be dealt a serious, if not fatal, blow. However, our clinic will survive and continue to offer services, and the fabric of the community will be a new and even stronger one.

We can only hope that our optimism and dedication will remain intact, and that PCMC will continue to be an inspiration and a fine example of how a community can, in fact, organize to meet its own needs.

We made the move over three days, on Dec. 19, Dec. 20 and Dec. 21, and opened for business Monday afternoon, Dec. 22. We were both exhausted and ecstatic.

As of Dec. 22, the lava was on track to reach the marketplace in at least 10 days.

Dan Domizio, MPH, PA-C, is the founder of Puna Community Medical Center in Pahoa, Hawai’i. He is a graduate of the Duke University PA program and a Duke University School of Medicine Hall of Fame inductee.